Endocrinology: DKA fluids: practice question

A Pediatrics question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pediatrics · Endocrinology: DKA fluids

Sample item

A child in DKA with moderate dehydration and normal perfusion needs fluid resuscitation. What is the recommended approach?

AHypotonic saline 0.45 percent for rapid correctionBRapid 40 ml/kg bolusesCIsotonic saline 10 ml/kg over 30 to 60 minutes, then gradual replacement over 24 to 48 hours with insulin infusion started afterwardsDInsulin bolus before any fluids

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Isotonic saline 10 ml/kg over 30 to 60 minutes, then gradual replacement over 24 to 48 hours with insulin infusion started afterwards

Current guidelines avoid rapid large-volume fluid boluses in DKA, because they are linked to cerebral oedema. Isotonic fluid is given 1 hour before starting insulin at 0.05 to 0.1 units/kg/hour, and deficits are replaced over 24 to 48 hours. Potassium is added once urine output is established.

Option by option

A. Hypotonic saline 0.45 percent for rapid correction
Hypotonic fluids increase the risk of cerebral oedema.
B. Rapid 40 ml/kg boluses
Rapid large boluses raise cerebral oedema risk.
C. Isotonic saline 10 ml/kg over 30 to 60 minutes, then gradual replacement over 24 to 48 hours with insulin infusion started afterwards (correct)
Correct. Cautious isotonic fluid first, then insulin.
D. Insulin bolus before any fluids
Insulin bolus is avoided and fluids come first.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this Pediatrics question

What is the answer to this Pediatrics question?

The best answer is C, Isotonic saline 10 ml/kg over 30 to 60 minutes, then gradual replacement over 24 to 48 hours with insulin infusion started afterwards. Current guidelines avoid rapid large-volume fluid boluses in DKA, because they are linked to cerebral oedema.

Why is "Hypotonic saline 0.45 percent for rapid correction" not the answer?

Hypotonic fluids increase the risk of cerebral oedema.

Why is "Rapid 40 ml/kg boluses" not the answer?

Rapid large boluses raise cerebral oedema risk.

Why is "Insulin bolus before any fluids" not the answer?

Insulin bolus is avoided and fluids come first.

What concept does this question test?

It tests Endocrinology: DKA fluids in Pediatrics. Isotonic fluid is given 1 hour before starting insulin at 0.05 to 0.1 units/kg/hour, and deficits are replaced over 24 to 48 hours. Potassium is added once urine output is established.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Endocrinology: DKA fluids?

Memorise milestones and the vaccine schedule as tables and revise them often. Then use the flashcards and the other Pediatrics questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.